Summary & Overview
CPT 37565: Internal Jugular Vein Ligation for Venous Hum Tinnitus
CPT code 37565 represents an open surgical ligation of the internal jugular vein via a neck incision, most commonly performed for venous hum tinnitus. The code captures a targeted vascular procedure with implications for surgical specialty billing, perioperative resource use, and post-procedural follow-up. Nationally, this code is relevant to hospital and ambulatory surgical center billing and to payers managing surgical coverage and utilization for ENT and vascular procedures.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical settings of service, and the types of benchmarks and policy items commonly reviewed for this code. Content addresses procedural definition, expected sites of service, common payer considerations, and areas where policy updates or coverage criteria can affect reimbursement and utilization management.
The publication provides practical reference material for coding teams and policy analysts: a clear description of the procedure tied to CPT code 37565, expected clinical indications, and an outline of the kinds of benchmarks and policy updates that influence payment and clinical authorization. Data not available in the input: associated taxonomies, specific ICD-10 diagnosis codes, related CPT/HCPCS codes, and payer-specific coverage rules.
Billing Code Overview
CPT code 37565 describes a surgical procedure in which the provider makes an incision in the neck to locate the internal jugular vein and ligates it with a suture or clip. This operation is most commonly performed to treat venous hum tinnitus, a vascular cause of tinnitus arising from turbulent flow in the jugular vein.
Service Type: Surgical — open ligation of internal jugular vein
Typical Site of Service: Hospital operating room or ambulatory surgical center, with the procedure performed by a surgical specialist in a controlled procedural setting.
Clinical & Coding Specifications
Clinical Context
A 45-year-old woman presents to otolaryngology clinic with several months of unilateral pulsatile tinnitus described as a whooshing sound synchronized with her heartbeat. Conservative measures including observation and medical management have failed, and diagnostic workup with temporal bone MRI and Doppler ultrasound demonstrates a prominent ipsilateral internal jugular vein creating a venous hum adjacent to the middle ear. After multidisciplinary review, the surgical plan is to perform an internal jugular vein ligation to eliminate the turbulent venous flow causing the tinnitus. The patient is admitted the day of surgery to a hospital operating room. Under general anesthesia, the surgeon makes a transverse cervical incision over the anterior border of the sternocleidomastoid, dissects to identify the internal jugular vein, and places suture ligatures (or clips) to occlude the vein segment. Hemostasis is confirmed, the wound is irrigated, and the incision is closed in layers. The patient is monitored in post-anesthesia care and typically discharged the same day or after an overnight observation depending on comorbidities. Documentation includes preoperative indication (e.g., venous hum tinnitus), informed consent, operative note with laterality and technique, estimated blood loss, implants or clips used, and postoperative instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity significantly exceeds typical for and supported by documentation. |